All GIC health plans feature a three-tier copay structure.
- Tier 1: You pay the lowest copayment. Most generic drugs fall into this tier.
- Tier 2: You pay the mid-level copayment. Many brand-name drugs fall into this tier.
- Tier 3: You pay the highest copayment. This tier includes brand-name and generic drugs that don’t fall into Tiers 1 or 2.
Covered drugs may change when ESI updates its drug formulary.
Medicare Part D Prescription Drug Coverage
- Do not enroll in a non-GIC Medicare Part D product. All GIC Medicare plans include Medicare Part D coverage. If you enroll in another Part D product, the Centers for Medicare and Medicaid Services will disenroll you from your GIC coverage. This means that you will lose your GIC health, behavioral health and prescription drug benefits.
- A “Notice of Creditable Coverage” is located in your plan handbook. It provides proof that you have comparable or better coverage than Medicare Part D. If you should later enroll in an individual Medicare drug plan because of changed circumstances, you must show the Notice of Creditable Coverage to the Social Security Administration to avoid paying a penalty.
- If you have extremely limited income and assets, contact the Social Security Administration to find out about subsidized Part D coverage.
- If your adjusted gross income, as reported on your federal tax return, exceeds a certain amount, Social Security will impose a monthly additional fee called IRMAA (Income-Related Monthly Adjustment Amount). Visit medicare.gov for more information. Social Security will notify you if this applies to you.
Prescription Drug Deductible
All GIC non-Medicare medical products have a fiscal year Rx deductible of $100 individual/$200 family. The prescription drug deductible is separate from your health product deductible. Once you’ve paid your prescription deductible, your covered drugs will be subject to copayment.